ACI Urology Network – Nursing Supra Pubic Catheter (SPC) - Adult Clinical Guideline, Competencies & Patient Information Leaflet Street address: Postal address: T +61 2 9464 4666 Level 4, Sage Building Agency for Clinical F +61 2 9464 4728 67 Albert Avenue Innovation [email protected] Chatswood NSW 2067 PO Box 699 www.aci.health.nsw.gov.au Chatswood NSW 2057 Acknowledgements Colleen McDonald (CNC Urology: Westmead Hospital), Karina So (CNC Urology: Concord Repatriation General Hospital), Virginia Ip (CNC Urology: Royal Prince Alfred Hospital), Michelle Paul (Nurse Practitioner: Community Health, Greater Newcastle Cluster), Wendy Watts (CNC Urology: John Hunter Hospital) and Suzanne Cruickshanks (CNC Continence: The Continence Service of the University Medical Clinics of Camden & Campbelltown Hospitals). Originally complied by Denise Edgar, Kylie Wicks, Claire Dobson, Choon Chew, Colleen McDonald, Melissa O’Grady, Lindy Lawler, Jacqui Swindells, Mary Kelly and Selvi Naidu. The following pages provide a clinical guideline template to enable clinicians to develop their own resource material relevant to their hospital and Area Health Service. They have been compiled by clinicians for clinicians. If you wish to use this material please acknowledge those that have kindly provided their work to enable use by others. Revise all material with colleagues before using to ensure it is current and reflects best practice. Disclaimer: The information contained herein is provided in good faith as a public service. The accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed. AGENCY FOR CLINICAL INNOVATION Level 4, Sage Building 67 Albert Avenue Chatswood NSW 2067 Agency for Clinical Innovation PO Box 699 Chatswood NSW 2057 T +61 2 9464 4666 | F +61 2 9464 4728 E [email protected] | www.aci.health.nsw.gov.au Produced by: ACI Urology Network Nurses Working Group Ph. +61 2 9464 4666 Email. [email protected] Further copies of this publication can be obtained from: Agency for Clinical Innovation website at: www.aci.health.nsw.gov.au Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the Agency for Clinical Innovation. © Agency for Clinical Innovation 2014 TABLE OF CONTENTS ASSESSING COMPETENCIES 4 What is a competency? 4 COMPETENCY: 4 Supra Public Catheter (SPC) change - Adult 4 RATIONALE 5 Indications for suprapubic catheterisation 5 CHANGING OF A SPC AND CARE - ADULT 7 Definition 7 Expected Outcome 7 Considerations 7 High Risk for Adverse Outcomes 8 Equipment 9 Procedures 9 REFERENCES 14 APPENDIX 1. 15 Competency Assessment Forms 15 1. Theory 15 2. Practical 16 APPENDIX 2. 20 Discharge Planning Checklist for Suprapubic Catheter 20 APPENDIX 3. 24 Questionnaire 24 Answers 25 APPENDIX 4. 27 Patient Education Leaflet 27 Troubleshooting: Problems You May Encounter 28 APPENDIX 5. 29 Supply of Equipment and Funding Bodies 29 Assessing Competencies What is a competency? Although the words sound alike, competence and competency are not synonymous. Competence refers to a potential ability, a capability to function in a given situation. Competency is defined as a combination of attributes enabling performance of a range of professional tasks to the appropriate standards. Competency focuses on your actual performance in a situation. This means you need competence before you can expect to achieve competency. Competence enables you to be capable of fulfilling your job responsibilities. Competency however, means that you fulfil your job as expected. Competency is determined by comparing where you are now with established performance standards developed in the work environment according to your role and setting1 Competency standards specify the level of achievement expected and the tasks and contexts of professional practice in which we may see the competency demonstrated. Competence does not mean expert. Various levels of competence exist and each of these has a minimum acceptable level or standard. Beginners are rarely expert however they can be competent. They perform a wide range of nursing activities methodically and well. The time to complete tasks may take longer however as skill level develops so too will proficiency. They have to ask many questions however are aware of which questions to ask. Competency: Supra Public Catheter (SPC) change - Adult The aim of the competency is to ensure the Nurse/Midwife/Medical Officer/Student is able to demonstrate prior knowledge and can perform suprapubic catheter change to the standard set by the Local Health District or Health Care Provider. It is necessary that the Nurse/Midwife/Medical Officer/Student have theoretical knowledge and technical skill. This knowledge may be gained by attending a study day or undertaking a learning package (discretion of each Local Health District). The Nurse/Midwife/Medical Officer/Student is required to undertake practical sessions with a supervisor in SPC change (competency). The supervisor is responsible for identifying the number of supervised sessions for each student in order to be deemed competent. A supervisor must be a clinician deemed capable of supervising SPC change. The Nurse/Midwife/Medical Officer/Student is responsible for maintaining their skill level. In the event where a clinician has been unable to undertake a catheterisation procedure for a significant period and feels they require supervision, it is their responsibility to contact the supervisor for additional supervision. Electronic records will be kept of each clinician that undertakes competency assessment, at the discretion of the Local Health District. Page 4/31 Rationale Indications for suprapubic catheterisation • No urethral access. • Failed urethral catheterisation. • Long term catheter management and quality of life. • Urethral trauma. Contraindication: • History of urothelial bladder cancer. N.B: Please refer to Local Health District Policy. Competency assessment is required because: • The ability to change a suprapubic catheter safely and effectively is an advantageous clinical skill for Nurse/Midwife/Medical Officer/Student. • Competent assessment and education of the patient/client requiring suprapubic change is necessary to minimise and prevent complications. Skill assessment in suprapubic catheter change procedure should be measured against the standard established in the relevant facility policy and protocol. Prerequisites prior to undertaking the skill assessment should include the following: • Attend an in-service or Introduction to Continence Program or a Urinary Catheterisation Workshop or education package. • Completed online Invasive Device Module (HETI Online). • Completed online Aseptic Technique Module (HETI Online). • Completed online Hand Hygiene Module (HETI Online). • Completed online Waste Management Module (HETI Online). • Has read the facility specific policy and procedure guidelines on suprapubic catheter change. • Has knowledge of the clinical indications for suprapubic catheter changes. • Observe a Nurse/Midwife/Medical Officer/Student who has achieved competency in this procedure. • Identify the WH&S principles that apply to the safe insertion of urinary catheters. Preparation for assessment • Schedule a time to attend a catheter clinic or liaise with an accredited assessor in your facility. • Discuss the assessment process with the patient in order to gain verbal consent. • Community nurses may be able to have their assessments completed in the patient’s home, subject to the patient’s consent and following negotiation with the appropriate staff member. Page 5/31 Essential components to be assessed • Patient gives consent where appropriate. • Professional attitude and rapport with the patient. • Comprehensive patient specific assessment and planning. • Performance of the suprapubic catheter change. • Problem-solving skills and application of theoretical aspect. • Infection control and aseptic technique. • Relevant occupational health and safety principles applied to the procedure. • Patient/carer/family information, education and follow up. Methods of assessment • Direct observation of the catheter change technique. • Questioning techniques. • Demonstrated problem-solving skills in relation to catheter management. Unsatisfactory Assessment In the event of an unsatisfactory assessment the assessor may use the following guide to manage and support staff training: • The assessor gives feedback on the observed deficits in the performance of the Nurse/Midwife/Medical Officer/Student. • The assessor determines with the Nurse/Midwife/Medical Officer/Student how the skill or knowledge deficit could be best improved. • Further educational support might be required to prepare the Nurse/Midwife/Medical Officer/Student for the repeat assessment. This will need to be negotiated between both parties and documented. • A repeat assessment is to be scheduled. • If three consecutive attempts are unsuccessful, a